Agriculture-Nutrition Field Note Training to Integrate Agriculture and Nutrition in Bangladesh

A Program Example from the Agriculture and Nutrition Global Learning and Evidence Exchange Landscape Analysis

April 2014

JSI Research & Training Institute, Inc. (JSI) • Helen Keller International (HKI) • International Food Policy Research Institute (IFPRI) • Save the Children (SC) • The Manoff Group (TMG)

The Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project is supported by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031. SPRING is managed by JSI Research & Training Institute, Inc.

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ACKNOWLEDGMENTS

A special thanks to the principal investigator and author of this document, Aaron Buchsbaum of the SPRING project. Also from the SPRING Project, Lidan Du led the Landscape Analysis team and provided valuable guidance and feedback. Anu Narayan, Deputy Director of SPRING, and Heather Danton, Director of Food Security at SPRING, provided invaluable direction and feedback. From the USAID Nepal Mission, a sincere thanks to Tahalia Barrett, Deputy Director, General Development Office; Hari Koirala, Senior Nutrition Specialist; Luis Guzman, Feed the Future Team Leader; and Navin Hada, Project Development Specialist, for their extensive and enlightening information about the Feed the Future work in country and the lessons they have learned from its implementation.

ABOUT SPRING

The Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) project is a five-year USAID-funded Cooperative Agreement to strengthen global and country efforts to scale up high-impact nutrition practices and policies and improve maternal and child nutrition outcomes. The project is managed by the JSI Research & Training Institute, Inc., with partners, Helen Keller International, the Manoff Group, Save the Children, and the International Food Policy Research Institute. SPRING provides state-of-the-art technical support and focuses on the prevention of stunting and maternal and child anemia in the first 1,000 days.

RECOMMENDED CITATION

SPRING. 2014. Training to Integrate Agriculture and Nutrition in Bangladesh: A Program Example from the Agriculture and Nutrition Global Learning and Evidence Exchange Landscape Analysis. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project.

DISCLAIMER

This message is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and Feed the Future, the U.S. Government's global hunger and food security initiative, under the terms of the Cooperative Agreement AID-OAA-A-11-00031 (SPRING), managed by the JSI Research & Training Institute, Inc. (JSI). The contents are the responsibility of JSI, and do not necessarily reflect the views of USAID or the U.S. Government.

SPRING Project JSI Research & Training Institute, Inc. 1616 Fort Myer Drive, 16th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: info@spring-nutrition.org Internet: www.spring-nutrition.org

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INTRODUCTION

Despite worldwide efforts to reach the Millennium Development Goal target of halving the proportion of

people who suffer from hunger by 2015, 165 million children remain stunted and 870 million people are

chronically undernourished. The 2013 Lancet Series on Maternal and Child Nutrition points to a growing

consensus that combating the global burden of malnutrition will require collaboration across development

sectors.

Recognizing the potential gains that can be made through better coordination, USAID’s Bureau for Food

Security and Bureau of Global Health commissioned the Strengthening Partnerships, Results, and

Innovations in Nutrition Globally (SPRING) project to lead a series of practical and program-driven

Agriculture and Nutrition Global Learning and Evidence Exchange (AgN-GLEE) events in Uganda,

Guatemala, and Thailand between December 2012 and March 2013.

To inform the agendas of the AgN-GLEEs, SPRING conducted a landscape analysis. Its purpose was to

review and synthesize current Feed the Future investments being made by USAID, extracting key data and

patterns from project documents and telephone interviews with USAID Missions. In addition to completing

landscape analysis reports for each of the 19 Feed the Future countries, SPRING also conducted several field

studies. These qualitative exercises were designed to gather, analyze, and summarize one or more practical

activities being carried out by either a USAID Mission or a Feed the Future implementing partner that

demonstrated potential for supporting nutritional outcomes within the country’s Feed the Future defined

zone of influence.

This field note examines the SPRING/Bangladesh project and its training of project and government

agents to deliver nutrition and hygiene messages alongside agricultural interventions at the community level.

Following this training, agents deliver messages during routine house visits and modified Farmer Field

Schools. A two-week field visit was carried out, using semi-structured interviews to gather information

from project staff; government extension agents and supervisors; partner project staff and senior technical

officers; and SPRING/Bangladesh Farmer Field School participants. Interviews took place in Dhaka and at

project sites in Barisal and Khulna Divisions. The goal was to gather information on: 1) what kinds of

messages are promoted during SPRING/Bangladesh nutrition trainings; 2) the rationale behind the

message selection; 3) training logistics and support; 4) uptake of messages by trainees; and 5)

comprehension of the messages by target community members. Information collected was analyzed using

the conceptual pathways between agriculture and nutrition1 to identify ways in which SPRING/Bangladesh

is linking agricultural interventions with nutritional outcomes.

1 The conceptual pathways between agriculture and nutrition help one understand how various agricultural investments or activities

could reach nutrition; how they affect and are affected by the enabling environment; and how they ultimately affect the nutrition of

women and children. The pathways framework has been adapted from Stuart Gillespie, Jody Harris, and Suneetha Kadiyala, The

Agriculture-Nutrition Disconnect in India, What Do We Know? IFPRI Discussion Paper 01187, June 2012. See Annex 1.

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BACKGROUND

SPRING/Bangladesh is a five-year USAID-funded project focused on the “1,000 days approach,”2

promoting essential nutrition and hygiene actions (ENHA) by pregnant and lactating women and children

under the age of two years. The project aims to improve the nutritional status of 350,000 households between

2011 and 2016, reaching targeted communities ( or unions) using multiple delivery channels that include

SPRING-led Farmer Field Schools, as well as training partnerships with government health agents,

agricultural extension agents, and development partner facilitators. Box 1 describes the Farmer Field School

activities and the ENHA messages selected by SPRING/Bangladesh.

2 The 1,000 days approach aims to improve nutrition from the start of a woman’s pregnancy through the first two years of her child’s

life. The right nutrition during this critical period has an enormous impact on a child’s ability to grow and learn.

Box 1. Linking Farmer Field Schools and Agriculture Trainings to ENHA

SPRING/Bangladesh Farmer Field Schools focus heavily on homestead food

production, including home gardening:

● Space planning ● Soil health management

● Vegetable bed / pit preparation ● Organic manure preparation

● Seed sowing ● Integrated pest management

● Seedling planting ● Seed production and storage

● Intercultural operation

Each Farmer Field School agricultural lesson also has integrated ENHA small doable

actions:

● Women’s Nutrition and Dietary Diversity ● Exclusive Breast Feeding, 0-6months-old

children

● Hand-washing before handling food ● Child Complementary Feeding and

Dietary Diversity

● Hand-washing after defecation

The same ENHA topics are taught to government agents and partner activity

technicians, in Farmer Field School communities*:

Ministry of Health and Family Welfare 3890

Ministry of Agriculture 896

Farmer Field School Facilitators 163

Partner Project Facilitators 610

* Data reflects period of September 2011 – April 2013

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Box 2. SPRING/Bangladesh Project Highlights

Adapts Farmer Field School model to focus on poor households with pregnant

and lactating women and children under 2, integrating homestead food

production with ENHA.

Advocates for government agriculture extension agents (Sub-Assistant

Agriculture Officers) to include 10 minutes of discussion on ENHA topics following

community extension sessions.

Co-targets households with pregnant and lactating women alongside partner

activity Feed the Future Aqua, to deliver both nutrition social and behavior

change communication and aquaculture trainings.

Has signed five letters of collaboration with partner activities, many of which

outline the roles and responsibilities for cross-trainings, monitoring, supervision,

and coordination of activities.

Has four letters of support and one tripartite memorandum of understanding

involving government directorates or services in agriculture, nutrition, and

health.

Farmer Field Schools

SPRING/Bangladesh is directly responsible for organizing, implementing, and monitoring Farmer Field

Schools that have been modified from the standard Farmer Field School approach to target attendance

exclusively by pregnant and lactating women.3 These Farmer Field Schools cover three major areas of

homestead food production: gardening, poultry-raising, and pond-fish farming. Homestead food production

approaches have long been employed in Bangladesh by organizations such as Helen Keller International

(HKI) and DANIDA; however, the integration of this food security approach into all-female Farmer Field

Schools is a new and potentially powerful approach to securing outcomes in agriculture and maternal and

child nutrition. Participants of each Farmer Field School live within one kilometer of the learning plot site,

must be functionally landless (<50 decimal land), and have an income of under $U.S. 50.00/month. They

receive seeds and financial assistance to construct poultry sheds. Farmer Field School facilitators conduct

monthly follow-up visits to each Farmer Field School participant. SPRING/Bangladesh began Farmer Field

School implementation in 15 subdistricts (“upazilas”) in June 2012, and has since expanded to 40 upazilas

across the USAID's Feed the Future intervention divisions of Khulna and Barisal.

PATHWAYS LINKING AGRICULTURE AND NUTRITION

Global evidence has led to the development of a theoretical framework that presents seven key pathways

linking agriculture and nutrition (Annex 1). While several of these pathways are being actively employed

3 Farmer Field Schools should reach 48,000 participants by Year 5.

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through interventions under SPRING/Bangladesh, the most salient connection between agriculture and

nutrition is via the Own Production Food Consumption pathway. The extensive ENHA trainings, as

well as the Farmer Field School model, reinforce combined and often complementary messages about the

steps necessary to plant, grow, harvest, cook, and consume nutritious foods at the household level.

Own Production Food Consumption

Improvements in production practices and diversification of crops can lead to better nutrition when coupled

with appropriate nutrition messaging. In the context of the 1,000 days approach, SPRING/Bangladesh uses

homestead food production as a centerpiece for promoting immediately accessible nutritious vegetables and

animal-source protein for pregnant and lactating women and children over six months of age. The nutrition

and agriculture cross-training of Farmer Field School facilitators allows them to directly bridge the practical

concerns of production (how to plant, how to save seeds, how to fertilize) with the behavioral and knowledge

components of consumption (what nutritious foods to grow, who should eat it, how to prepare it). In this

way, the Farmer Field School can be considered SPRING/Bangladesh’s practical alignment with the

conceptual pathways between agriculture and nutrition.

In addition, SPRING/Bangladesh conducts nutritional cross-training for production-focused government

extension agents or partner project facilitators, effectively adding an ENHA component to its scope of work,

and in some cases, co-targeting households with pregnant and lactating women and children. In the case of

sub-assistant agricultural officers, most beneficiaries are male rice growers, meaning there will be less

immediate connection between growing nutritious foods at the household level and having it consumed by

SPRING/Bangladesh targets. In all cases, however, SPRING/Bangladesh trainings focus on the capacity to

disseminate the same ENHA messages, such that Farmer Field School facilitators, subassistant agricultural

officers, project partners, and community health agents consistently promote food utilization behaviors.

TRAINING PHILOSOPHY AND APPROACHES

SPRING/Bangladesh acts as a “Master Trainer” for an array of government and project technical partners by

planning, designing, and conducting ENHA training sessions, either directly to community agents or as part

of a cascade “Training of Trainers” (see figure on page 5). These trainings began in 2011 and benefit from

strong government and project partnerships.

The cross-training component of SPRING/Bangladesh is based on evidence from prior activities and

conceptual frameworks, including BASICS in Madagascar, Alive & Thrive in Bangladesh, and the UNICEF

conceptual framework on nutrition. Additional consultations with IFPRI, Save the Children, HKI, and the

Ministry of Health and Family Planning helped determine which nutrition and hygiene messages were most

likely to result in the behavior change necessary for nutrition impacts. This idea is captured by the phrase

“Small Do-Able Actions”—those nutrition and hygiene behaviors most easily implemented by a household,

regardless of means or prior education. SPRING/Bangladesh selected from among the 12 ENHA topics a

total of 5 (see Box 1) that can be directly tied to homestead food production, are most critical to nutrition for

pregnant and lactating women and children under two years of age, and can be understood and practiced by

vulnerable and landless families.

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The figure illustrates the SPRING/Bangladesh training structure. It highlights the different channels—

Farmer Field Schools, government, and partner projects—along with respective actors implicated in training

on, and delivery of, select ENHA.

Figure. The SPRING/Bangladesh Training Structure4

Particularly important to its cross-training approach, SPRING/Bangladesh streamlined the instruction and

delivery of messages so that government service providers and project facilitators will not feel overburdened

when asked to effectively expand their scope of work. Streamlining also helps minimize the dissemination of

incorrect information; the less material cross-trained agents are asked to memorize, understand, and

disseminate, the less likely participants will receive inaccurate information. Finally, standardizing the ENHA

messages through multiple channels puts key social and behavior change communication principles into

practice, as the same information is reinforced through Farmer Field Schools and government and project

partners. For a detailed list of elements in the SPRING/Bangladesh training approach, see Annex 2.

CHALLENGES

SPRING/Bangladesh’s approach to agriculture-nutrition cross-training partnerships promotes the

dissemination of ENHA messages through multiple channels, but faces a number of ongoing challenges

related to cross-training buy-in, monitoring and evaluation, dissemination, and workload.

Pregnant and lactating women contribute the majority of labor for homestead food production, which

can negatively affect healthy pregnancy and time for child care.

4 Upazilas are the largest municipal unit in Bangladesh, and are further divided into unions

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Working through staff funded by governments and activities separate from SPRING presents challenges

of oversight, and SPRING has no mandate to dictate staff activities.

Production technicians in partner activities may view nutrition training as creating extra work for which

they were not previously responsible. Consequently, clear communication is needed between supervisory

and field staff.

Currently, no system exists to assess the impact of nutrition messaging delivered by subassistant

agricultural officers, reducing the certainty that cross-training is supporting nutrition outcomes.

Additional complexities with monitoring and evaluation arise when determining how many Farmer Field

School participants are at the same time receiving visits from SPRING-trained community agents within

the Ministry of Health and Family Welfare.

While SPRING/Bangladesh is taking a leadership role as an ENHA trainer, discrepancies in message

content may occur when delivered by other channels to target community members, which can affect the

uptake of new behaviors.

Farmer Field School facilitators are expected to provide their own transport to eight Farmer Field

Schools every two weeks, in addition to 160 participants that must receive household visits each month.

CONCLUSION

The SPRING/Bangladesh project offers several important lessons. The first is around the adaptation of the

Farmer Field School model, which typically is reserved for male farmers. SPRING/Bangladesh has used the

Farmer Field School approach to instead focus hands-on agricultural trainings for pregnant and lactating

women, promoting up to three varieties of homestead food production (pond-fish aquaculture still according

to availability of water). The inclusion of targeted ENHA activities is likewise a new approach and there is

great interest in seeing whether the selected Small Do-Able Actions are effectively translated into results such

as improved hand-washing, increased complementary feeding frequency, and improved nutrition for pregnant

and lactating women. At the same time, a nine-month, biweekly class is no small undertaking and, while it

creates significant opportunities around homestead food security, it also demands time and energy among a

nutritionally vulnerable population.

Regarding the cross-training of production agents (agriculture, horticulture, aquaculture) in government

agencies or technical projects, SPRING/Bangladesh is clearly focused on identifying partners, advocating for

cross-training and— in certain cases—co-targeting. Perhaps the greatest achievement to date is building and

maintaining a role as master trainer for its own brand of selected ENHA messages; SPRING/Bangladesh

appears well accepted by the health and agricultural ministries, which strongly indicates the messaging is

approved by the Bangladeshi government and not overly redundant or in conflict with other initiatives. The

close ties with the agricultural ministry, and the department of extension in particular, is laudable—the only

caveat in terms of lessons learned is that not every project will benefit from such willing government partners.

Finally, mapping SPRING/Bangladesh onto the pathways between agriculture and nutrition framework,

project activities fit predominantly within the Production Consumption pathway. The modified Farmer

Field School combines practical knowledge on establishing and maintaining homestead food production, with

both improved food utilization and hygiene practices targeted toward pregnant and lactating women and

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children under two years of age. Similarly, the use of other production agents and government extension

services to reinforce nutrition messaging falls along similar lines—placing nutrition knowledge in the hands of

producers, commercial and homestead alike.

FUTURE RESEARCH QUESTIONS

This brief field note was based on initial desk research, interviews with donors and activity staff, and one site

visit by SPRING research staff. As with any field research, the visit raised additional areas of inquiry that are

of interest. Some of the potential research questions may already be part of the Mission or project’s learning

agenda. For SPRING/Bangladesh, the following research questions warrant additional consideration:

How effective is the Farmer Field School training format in delivering ENHA messages, and what are its

advantages and disadvantages compared with other methods? Do ENHA messages benefit from the

same practice and discovery-based training approach of Farmer Field Schools? Are there observed

advantages in limiting participation to women only? How effective are nutrition messages delivered by

agricultural agents versus health agents?

How do the homestead food production activities targeted to women affect the health of pregnant

women and the time availability and energy levels of lactating mothers? How does the project mitigate

the negative effects on mother’s health, and the care and feeding of infants?

Homestead food production may directly increase household food consumption, diet diversity, and

individual food intake, but the impact on child nutrition outcomes is less direct as health and care

determinants become prominent. Given this context, what activity approaches are most promising for

influencing intra-household behavior that could likely impact mother and child health and nutrition?

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ANNEX 1. PATHWAYS FRAMEWORK

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The Seven Key Pathways Between Agriculture and Nutrition

Pathway 1: Own Production Food Consumption

Own agricultural production—food consumption—nutrient intake—child nutrition outcomes

Agriculture as a source of food, the most direct pathway by which household agricultural production

translates into consumption (through crops or livestock cultivated by the household)

Pathway 2: Income Food Purchase

Income (agricultural or nonagricultural)—food expenditure—food consumption—nutrient intake—child

nutrition outcomes

Agriculture as a source of income spent on purchasing diverse nutritious foods, either through wages earned by

agricultural workers or through the sale of agricultural goods

Pathway 3: Income Healthcare Purchase

Income (agricultural or nonagricultural)—nonfood expenditure—healthcare expenditure (cost)—health

status—child nutrition outcomes

Agriculture as a source of income spent on nonfood items, particularly health, either through wages earned by

agricultural workers or through the sale of agricultural goods

Pathway 4: Food Prices Food Purchase

Supply and demand factors (policies, taste, incomes)—relative prices of various food items—food

expenditure

The link between agricultural policy and food prices, involving a range of supply-and-demand factors

that affect the prices of various food and nonfood crops, which, in turn, affect the incomes of net

sellers and the ability to ensure household food security (including diet quality) of net buyers

Pathway 5: Women’s Time Use Care Capacity

Female employment in agriculture—time use/caring capacity—child nutrition outcomes

Women’s time use, and subsequent ability to manage the care, feeding, and health of young children

alongside agricultural work

Pathway 6: Women’s Workload Maternal Energy Use

Female employment in agriculture—energy expenditure—maternal and child nutrition outcomes

Women’s workload and work-related energy expenditure, and subsequent effects on child nutrition and

health through the lifecycle, including during pregnancy

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Pathway 7: Women’s Control of Income Resource Allocation

Female employment/resources —female socioeconomic power—household expenditure (food/health)—

intra-household allocation—maternal and child nutrition outcomes

Women’s control of household income and their ability to influence household decision-making and

household allocation of resources for food, health, and care

Adapted from Stuart Gillespie, Jody Harris, and Suneetha Kadiyala, The Agriculture-Nutrition Disconnect in India, What Do

We Know? IFPRI Discussion Paper 01187, June 2012.

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Annex 2. Outline of Training Approaches in

SPRING/Bangladesh

Training of Farmer Field School Facilitators

Facilitators receive a six-day intensive course led by SPRING senior technical officers in nutrition,

agriculture, animal husbandry, and aquaculture.

SPRING/Bangladesh adapted training materials and practical agricultural sessions from Danish

International Development Assistance (DANIDA) Farmer Field Schools and Helen Keller International

homestead food production experience in Bangladesh.

Facilitators receive a 110-page training manual in the local language comprised of 18 sessions, for

reference in their work with the Farmer Field School beneficiaries.

Farmer Field School Training and Participants

Farmer Field Schools are made up of 20 to 25 participants who meet once every two weeks to learn

about homestead food production, poultry rearing, and ENHA.

Sessions are conducted at “learning plots” near participants’ households to facilitate hands-on

participation and learning during agricultural lessons.

Participants of each Farmer Field School live within one kilometer of the learning plot site. All

participants receive seeds and monetary assistance to construct poultry sheds.

Farmer Field School facilitators pay monthly follow-up visits to each Farmer Field School participant.

The selection of pregnant and lactating women is based on antenatal care visit records, child’s birth

registration, or clinic discharge date. Participants must be functionally landless (<50 decimal land) and

have an income of under $50 per month.

Participants cannot be part of similar agriculture or nutrition program under Feed the Future.

Training of Ministry of Agriculture Extension Agents

Subassistant agricultural officers receive two-day intensive ENHA cross-trainings led by SPRING senior

technical officers and upazila coordinators. Each session includes 18–25 sub-assistant agricultural

officers.

Trainings include household negotiation social behavior change communication approaches such as

GALIDRAA, which guide extension agents in how to effectively communicate nutrition messages to

their target audience.

The Department of Agricultural Extension has issued a letter of support to SPRING and often

subsidizes the venue cost for the subassistant agricultural officer trainings.

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Trainings complement the Department of Agricultural Extension mandate to reach women in 25 percent

of all community extension sessions, due to the SPRING/Bangladesh focus on nutrition of pregnant and

lactating women and women-led homestead food production.

Training of Ministry of Health and Social Welfare Agents

Health inspectors, assistant health inspectors, and family planning inspectors receive a four-day intensive

training of trainers to reinforce ENHA knowledge and counseling practices.

These supervisory-level health workers then co-facilitate cascade trainings—with support from SPRING

upazila coordinators—for union-level frontline health agents.

Training of Partner Project Facilitators and Field Technicians

Trainings are similar to those for sub-assistant agricultural officers in messages and social behavior

change communication techniques. They are provided to SPRING-identified projects that promote

agriculture or aquaculture at the community level.

Funding for training space, materials, and facilitators are provided by SPRING/Bangladesh. Funding for

trainees is covered by project partners. This arrangement is clearly defined in letters of collaboration.